Provider Demographics
NPI:1891184081
Name:BURCHARDT, DEBORAH (RD,LD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BURCHARDT
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 N HILLSIDE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4940
Mailing Address - Country:US
Mailing Address - Phone:316-962-8085
Mailing Address - Fax:316-962-8010
Practice Address - Street 1:551 N HILLSIDE ST STE 102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4940
Practice Address - Country:US
Practice Address - Phone:316-962-8085
Practice Address - Fax:316-962-8010
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered